Health Inequality Aversion in the United States

Area of Science:

• Health Economics
• Public Health Policy
• Social Determinants of Health

Background:

• Health inequality aversion parameters are crucial for distributional cost-effectiveness analysis (CEA).
• These parameters balance societal preferences for overall health gains (efficiency) with reducing disparities between advantaged and disadvantaged groups (equity).
• Eliciting these parameters for the US population is essential for accurate equity-focused healthcare policy.

Purpose of the Study:

• To elicit a health inequality aversion parameter specifically for the US population.
• To quantify societal preferences regarding trade-offs between health efficiency and equity.
• To inform the integration of equity considerations into US healthcare decision-making.

Main Methods:

• Adapted a UK-based benefit trade-off (BTO) instrument for online survey administration.
• Collected data from a representative sample of the US adult general public (June-December 2023).
• Analyzed response patterns to classify inequality aversion and derive equity weights, considering demographics and social vulnerability indicators.

Main Results:

• Analyzed 1290 complete responses from 1864 participants, with a sample representative of US Census data.
• The median Atkinson parameter was 12.12, with an implied equity weight of 6.7.
• A significant majority (88%) were willing to trade off total health to reduce health inequality; lower income and minority groups showed slightly higher aversion.

Conclusions:

• Derived inequality aversion statistics support the routine integration of equity into US healthcare policy and health technology assessment.
• Findings advocate for advancing distributional cost-effectiveness analysis by incorporating measured societal preferences for equity.
• The study provides empirical evidence for prioritizing health equity in policy decisions.